Common fractures in all age groups

A fall on the shoulder or the outstretched

hand may break the clavicle.
In the common mid-shaft fracture, the outer
fragment is pulled down by the weight of
the arm
In fractures of the outer end, if the
ligaments are intact there is little
displacement; but if the coracoclavicular
ligaments are torn, displacement may be
severe and closed reduction impossible.

Group I (middle third fractures),

Group II (lateral third fractures)
Group III (medial third fractures).

Arm clasped to chest

Subcutaneous lump or sharp fragment
Palpate pulse at root of neck for vascular
involvement

Non-operative management consists of

applying a simple sling for comfort.
It is discarded once the pain subsides
(between 13 weeks)
patient is then encouraged to mobilize the
limb as pain allows.
Figure of 8 bandage

Operative management
Internal fixation with plating or screwing for
displaced fractures

Non operative management

Sutures & grafts when necessary

Treatment consists of a sling for 23 weeks

until the pain subsides, followed by
mobilization within the limits of pain
Surgical Techniques include the use of a
coracoclavicular screw, plate and hook plate
fixation and suture and sling techniques

-Immediate:

Subclavian Vessels injury

Neurological damage- Brachial

plexsus
Late: Malunion:
Problem : Cosmetic
Treatment- NOTHING
Nonunion:
Treatment if symptomatic
Open reduction + Internal Fixation:
Plating
+ Bone grafting.
Fear: Sub Cut. Bones so if skin
necrosis:
bone gets exposed.

The body of the scapula is fractured by a

crushing force
The neck of the scapula may be fractured
by a blow or by a fall on the shoulder;
The coracoid process may fracture across
its base or be avulsed at the tip.
Fracture of the acromion is due to direct
force.
Fracture of the glenoid fossa usually
suggests a medially directed force

The arm is held immobile and there may be

severe bruising over the scapula or the
chest wall.
Neurological & vascular symptoms might be
present

Body fractures
Surgery is not necessary. The patient wears
a sling for comfort, and from the start
practises active exercises to the shoulder,
elbow and fingers

Glenoid fractures
Type 1 # - surgical fixation should be
considered.
Anterior rim fractures are approached
through a delto-pectoral incision and
posterior rim fractures through the posterior
approach.
Type 2 # - ORIF
Type 3 to 6 # - poor indication for surgery

Fractures of the proximal humerus usually

occur after middle age and most of the
patients are osteoporotic, postmenopausal
women.
Fracture usually follows a fall on the outstretched arm

c/o: Pain , swelling and painful

movements.
Examination:
Inspection-Deformity , ecchymosis
Palpation -Tenderness, bony crepitations
abnormal mobility.
Neurological: Axillary Nerve Injury Deltoid Muscle paralysis- loss of abduction.
Movements: Very Painful , active- not
possible
Measurements: short arm length.

Xray:
Shoulder with Arm:
AP & Lat.
Site:
Anatomical neck, surgical neck ,
GT,LT
Pattern: Impacted
Displaced

Fractures of surgical neck

The fragments are gently manipulated into
alignment and the arm is immobilized in a
sling for about four weeks or until the
fracture feels stable
if the fracture is very unstable then fixation
is required.
Options include percutaneous pins, bone
sutures, intramedullary pins with tension
band wiring or a locked intramedullary nail.

Greater tuberosity fractures

Conservative reduction in position
If it does not reduce, the fragment can be
re-attached through a small incision with
interosseous sutures
Anatomical neck fractures
screw attachment
hemiarthroplasty

ORIF

high risk of complications such as vascular

injury, brachial plexus damage, injuries of
the chest wall and avascular necrosis of the
humeral head.
Reconstruction
Prosthetic implant if applicable